Successful transition to outpatient total joint arthroplasty

Aug. 06, 2021

Mayo Clinic is performing a growing proportion of total hip and knee arthroplasty procedures on an outpatient basis, in line with the orthopedic surgery field's increasing interest in same-day hospital discharge. Successful outpatient joint replacement requires an experienced, multidisciplinary care team and strict adherence to evidence-based protocols.

"We have dedicated the resources necessary to educate patients before their procedures, to execute efficient and safe surgeries, and to provide a rapid recovery, including same-day physical therapy before patients go home," says Cameron K. Ledford, M.D., an orthopedic surgeon at Mayo Clinic in Jacksonville, Florida. "If qualified surgical candidates choose to have an outpatient procedure, our model of care can provide it."

Between 5% and 10% of patients in the United States who have hip or knee arthroplasty have an outpatient procedure. At the Jacksonville campus of Mayo Clinic, that proportion is about 15%.

"We began the transition to outpatient arthroplasty before the outbreak of COVID-19," Dr. Ledford says. "But the outbreak helped move that transition forward. More patients are asking us if they can have outpatient procedures and avoid any hospitalization."

To qualify for outpatient hip and knee arthroplasty, patients must be in overall good health and motivated to perform physical therapy after surgery. They also must have a supportive environment for postoperative recovery and rehabilitation.

"Patient selection is especially important to optimizing outcomes," Dr. Ledford says. "Once we identify that a patient is eligible and willing to have outpatient total joint arthroplasty, we provide thorough education on both the type of procedure the patient is having and the expectations for postoperative recovery. Patient motivation is key."

At Mayo Clinic, outpatient arthroplasty procedures are scheduled in the early morning. "You have to have a clinical and surgical team with expertise and intraoperative resources performing the surgery at a high level," Dr. Ledford says. "A successful program requires adherence to evidence-based protocols on preoperative patient optimization, blood conservation, wound and pain management, blood clot prevention, and rehabilitation."

غرفة مجهزة كغرف الإقامة الداخلية بالمستشفى غرفة مجهزة كغرف الإقامة الداخلية بالمستشفى

تتوفر غرف شبيهة بغرف المستشفى في الجناح الجديد لوحدة الإقامة القصيرة في مستشفى مايو كلينك في جاكسونفيل بفلوريدا للانتقال إليها بعد استبدال المفصل الكامل في العيادة الخارجية.

غرفة العلاج الطبيعي غرفة العلاج الطبيعي

تستخدم غرفة العلاج الطبيعي في الجناح الجديد لوحدة الإقامة القصيرة في مستشفى مايو كلينك في جاكسونفيل بولاية فلوريدا لمساعدة المرضى في تحقيق مراحل معينة من العلاج قبل الخروج في اليوم نفسه.

The surgeries are performed using a short-acting spinal anesthesia. Afterward, patients go to a recovery unit and then to a specially designed short stay unit. "Physical therapists work there with patients for one or two hours," Dr. Ledford says. "Once the patients pass the milestones necessary to safely go home, they're discharged — usually before dinner."

He notes that outpatient joint replacement can have positive outcomes similar to inpatient procedures when the outpatient procedure is executed according to protocols. "Mayo Clinic has a history of successful teamwork and an environment designed to optimize surgical outcomes," he says. "This outpatient arthroplasty program is an extension of that Mayo Clinic value system."